Results from a 2018 qualitative study in Kenya suggest that scaling up vasectomy services could help the country build on decades of family planning progress and help achieve its family planning goals, including increasing its modern contraceptive prevalence rate (mCPR) to 66% by the year 2030.

IntraHealth International conducted the study with 19 vasectomy clients, seven vasectomy providers, and eight county health officials to learn more about why—despite significant increases in the use of other modern forms of contraception—a negligible number of women (0.0% in the last national demographic and health survey) reported relying on a partner’s vasectomy for contraception.

“We know there is strong demand for family planning throughout Kenya and that the government is committed to increasing access to everyone who needs services, yet vasectomy has been largely ignored as a priority method,” says Boniface Sebikali, senior clinical advisor at IntraHealth and the lead researcher on the study. “We wanted to learn more about the barriers and opportunities for scaling up vasectomy services from those who would know the method best.”

Kenya's gains have led to significant improvements in health.

Kenya’s family planning program is among the most successful in the region. The country raised its mCPR among married women from 39% in 2008–2009 to 53% in 2014, surpassing its goal of 52% by 2015. And by 2017, mCPR in Kenya had reached 61%.

These gains have led to significant improvements in health. According to FP2020, in 2017 Kenya averted 1,472,000 unintended pregnancies, 438,000 unsafe abortions, and 5,000 maternal deaths due to the use of modern contraceptives.

Kenya also hopes to reap the economic benefits of family planning and achieve the demographic dividend—a period of accelerated economic growth that can result when the size of a country's young dependent population declines in relation to the working-age population.

But despite the fact that vasectomy is highly effective, easy to provide, and (along with female sterilization) one of only two permanent methods of contraception, it has not yet become a major part of Kenya’s family planning strategy.

Why vasectomy in Kenya?

In 2017, Nairobi hosted World Vasectomy Day—a global campaign to start conversations, help men and families make more informed choices, and create alliances with governments and organizations that can train providers, educate families, and deliver vasectomy services. 

Seventy-four men in Kenya elected to receive vasectomies as part of the campaign, and an additional 200 men participated in a men’s health fair to learn more about family planning options, including vasectomy. This participation demonstrates that with the right information and availability of services, the procedure appeals to some Kenyan men and families.

This led IntraHealth to partner with the Ministry of Health to further investigate the motivations and barriers behind vasectomy use. The study focused on vasectomy users, providers, and stakeholders from four counties (Nairobi, Kakamega, Busia, and Kisumu) where World Vasectomy Day events had led to modest increases in vasectomy uptake.

Study participants consistently reported the same underlying reasons for choosing vasectomy, which echo those reported by clients worldwide:

• Desire to take joint responsibility of family planning
• Desired number of children already achieved
• Economic constraints of raising children and affording contraceptives
• Dissatisfaction with other contraceptive methods
• Concern for their partner's health

“After seeing the problems my wife had undergone, multiple cesarean-sections, and having achieved the number of children we wanted, we thought of vasectomy,” said one study participant. “I had been told it would have a 98.9% success rate, hence I considered it to be the best method, so that whenever we had an intercourse, I would not be bothered.”

The study also investigated the demand- and supply-side barriers to ramping up vasectomy for men and couples who want to permanently avoid future pregnancies. Challenges included:

• Myths and misconceptions, including confusion between castration and vasectomy and fear of reduced sexual ability
• Social stigma
• Perception of family planning as being “women’s business”
• Small number of trained providers in vasectomy
• Lack of supplies (no-scalpel kits)
• Poor data management for vasectomy

“Vasectomy is not really in the open like other methods, and the community cannot be blamed since the government has not put a lot of emphasis on it,” says one health official who participated in the study. “The county also lacks the skilled providers to provide vasectomy services to the community. Vasectomy has not really been embraced though some people are aware and a few men have spoken openly.”

The study’s recommendations include:

• Working with vasectomy champions, including clients to dispel myths and misconceptions and destigmatize the procedure.
• Implementing demand-creation activities centered on messages that resonate with vasectomy clients.
• Engaging and training health workers to provide accurate information on vasectomy.
• Training more vasectomy providers (in-service and preservice).

Read more about IntraHealth's work in Kenya.

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